Information Control Problems in Manufacturing

Proceedigs of the 15th IFAC Symposium on

May 11-13, 2015.
Proceedigs
Proceedigs theOttawa,
of the Canada
15th IFAC
IFAC Symposium on
Information of
Control15th
ProblemsSymposium on
Available
in Manufacturingonline at www.sciencedirect.com
Information
Information Control
Control Problems
Problems in
in Manufacturing
Manufacturing
May 11-13, 2015. Ottawa, Canada
May
May 11-13,
11-13, 2015.
2015. Ottawa,
Ottawa, Canada
Canada
ScienceDirect
Multi-ObjectiveIFAC-PapersOnLine
Evolutionary 48-3 (2015)
for 704–709
Multi-Skill Health Care Tasks
Multi-Objective Evolutionary
Multi-Objective Evolutionary for
for Multi-Skill
Scheduling Multi-Skill Health
Health Care
Care Tasks
Tasks
Scheduling
Scheduling
Sarah Ben Othman*. Slim Hammadi*. Alain Quilliot**
*Sarah
EcoleBen
Centrale de Lille,
Othman*. SlimLAGIS UMR 8219,
Hammadi*. AlainLille, France
Quilliot**
Sarah
Sarah
(e-mail: Ben
Ben Othman*.
Othman*. Slim
Slim Hammadi*.
Hammadi*.
sara.ben.othman@hotmail.fr, Alain
Alain Quilliot**
Quilliot**
slim.hammadi@ec-lille.fr)
** Ecole Centrale de Lille, LAGIS UMR 8219, Lille, France
**University *ofEcole
(e-mail: Ecole Centrale
Blaise Pascal, de
Centrale de Lille, LAGIS
Lille, UMR
LIMOS UMR
LAGISCNRS
sara.ben.othman@hotmail.fr, UMR 8219, Lille,
Lille, France
8219,Clermont-Ferrand,
6158, France
slim.hammadi@ec-lille.fr) France
(e-mail:
(e-mail: sara.ben.othman@hotmail.fr,
sara.ben.othman@hotmail.fr,
(e-mail: slim.hammadi@ec-lille.fr)
slim.hammadi@ec-lille.fr)
alain.quilliot@isima.fr)
**University
**University of Blaise Pascal, LIMOS UMR CNRS 6158, Clermont-Ferrand, France
**University ofof Blaise
Blaise Pascal,
Pascal, LIMOS
LIMOS
(e-mail:
UMR
UMR CNRS
CNRS 6158,
6158, Clermont-Ferrand,
Clermont-Ferrand, France
alain.quilliot@isima.fr) France
(e-mail: alain.quilliot@isima.fr)
(e-mail: alain.quilliot@isima.fr)
Abstract: Emergency health care services have a highly complex patient treatment system. This system is
characterized
Abstract: Emergency by stochastic health arrivals of patients
care services have which can lead
a highly in thepatient
complex case oftreatment
activity tosystem.its servicesThis overload.
system is
fact, theEmergency
Abstract:
Abstract:
In
characterized Emergency
complexity
by stochastic
health
health
of these care
arrivals
services
caremedical
services have
have
exercises
of patients
aa highly
which highly
relays complex
complex
can leadon in patienthealth
thepatient
treatment
case oftreatment
assigning caretosystem.
activity system.
operations
its services
This system
Thistooverload.
system
medical is
is
characterized
characterized
staff members by
by stochastic
stochastic
respecting arrivals
arrivals
constraints of
of patients
patients
related which
which
to the can
can lead
lead
uncertain in
in the
the case
case
environment. of
of activity
activity
The to
to its
its
objective services
services
is to overload.
overload.
minimize
In fact, the complexity of these medical exercises relays on assigning health care operations to medical
In
In fact,
fact,andthe
the complexity
complexity of these
of constraints
these the medical
medical exercises
exercises relays
well on
relays on assigning
assigning health
health care
care operations
operations to medical
costs
staff members delays and to increase
respecting quality
related oftocaretheas as patient
uncertain satisfaction.
environment. The In this
objective is toto
article, medical
aminimize
planning
staff
staff
method members
members
is appliedrespecting
respecting
in the constraints
constraints
Pediatric related
related
Emergency to
to the
the uncertain
uncertain
Department of environment.
environment.
the Regional The
The objective
objective
University is
is
Hospitalto
to minimize
minimize
of Lille
costs and delays and to increase the quality of care as well as patient satisfaction. In this article, a planning
costs
costs
(Northernand
and delays
delays and
and
France).The to
to increase
increase
proposed the
the quality
quality
approach of
ofiscare
care as
as
composedwell
well as
as
of patient
patient
two satisfaction.
satisfaction.
phases: the In
In
first this
this
one article,
article,
is an aa planning
planning
assignment
method is applied in the Pediatric Emergency Department of the Regional University Hospital of Lille
method
method is applied
appliedonin
is France).The the
infuzzy Pediatric
theproposed
Pediatric Emergency
Emergency Department
Department of
oftwothe
the Regional
Regional University Hospital of
of Lille
procedure
(Northern based logic and the second
approach phase is of
is composed based on theUniversity
an evolutionary
phases: first one methodHospital
is an toassignment
solve Lille
the
(Northern
(Northern
problem of France).The
France).The
medical staff proposed
proposed
scheduling. approach
approach
This is
is composed
composed
approach improves of
of two
two
the phases:
phases:
performance the
the first
first
of the one
one is
is
scheduling an
an assignment
assignment
system in
procedure based on fuzzy logic and the second phase is based on an evolutionary method to solve the
procedure
procedure
order to based
based
help on
on
physicians fuzzy
fuzzy to logic
logic
better and
and
managethe
the second
second
their phase
phase
organizationis
is based
based
and on
on an
an
anticipate evolutionary
evolutionary
the overcrowdingmethod
method to
to solve
solve
feature. the
the
This
problem of medical staff scheduling. This approach improves the performance of the scheduling system in
problem
problem
work of
of
is help medical
medical
integrated staff
staff to
into scheduling.
scheduling.
HOST This approach
This(Hospital:
approach improves
improvesand the performance
theanticipate
performance of
of the scheduling
theCrowding
scheduling system
system in
in
order to physicians betterproject
manage their Optimization,
organization Simulation the and
overcrowding Avoidance)
feature. This
order
order
supportedto
to help
help physicians
physicians
and financed to
to better
better manage
manage their
their organization
organization and
and anticipate
anticipate the
the overcrowding
overcrowding feature.
feature. This
This
work is integrated into by HOSTthe FrenchprojectNational
(Hospital: Agency (ANR). Simulation and Crowding Avoidance)
Optimization,
work
work is
is integrated
integrated into
into HOST
HOST project (Hospital:
projectNational
(Hospital: Optimization,
Optimization, Simulation
Simulation and and Crowding
Crowding Avoidance)
Avoidance)
© 2015, IFAC
supported
Keywords:
supported
supported
and
and
and
financed
(International
Planning
financed
financed
by
Method,
by
by
the
the
the
French
Federation
Pediatric
French
French of Automatic
Emergency
National
National
Agency
Agency
Agency
(ANR).
Control)
Department,
(ANR).
(ANR). Hosting by ElsevierFuzzy
Assignment, Ltd. All rightsEvolutionary
Logic, reserved.
Method, Medical
Keywords: PlanningStaff Scheduling,
Method, PediatricPerformance.
Emergency Department, Assignment, Fuzzy Logic, Evolutionary
Keywords: Planning
Keywords: Planning Method,Method, Pediatric
Pediatric Emergency
Emergency Department,
Department, Assignment,
Assignment, Fuzzy Fuzzy Logic,Logic, Evolutionary
Evolutionary
Method,
Method, Medical
Medical Staff
Staff Scheduling,
Scheduling, Performance.
Performance.
Method, Medical Staff Scheduling, Performance.
1. INTRODUCTION Health care systems are thus complex systems facing a huge
numbercare
Health of challenges
systems arerelated
thus to production
complex systems functions
facing below
Health care facilities, 1. INTRODUCTION
which represent a growing sector, are Health
1. INTRODUCTION
INTRODUCTION Health
the care and
care
optimal systems
systemsproblemsare thus
are thus complex systems
complex
of information systems facing aaa huge
facing
flow.functions
huge
huge
1. number of challenges related to production below
confronted in recent decades to a mutation imposed by their number of
number of challenges
challenges related related to to production
production functions
functions below below
Health care facilities, which represent a growing sector, are the
In optimal
this work, and problems
we consider of information
the scheduling flow.
Health care
Health
providerscare andfacilities,
facilities, which represent
which
their consumers. represent
Ita ismutationaa growing
essentialgrowingthat thesector,
sector,
offeredare the
are the optimal
optimal and problems
and problems of information
of information flow. problem in
flow.
confronted
confronted in
in recent
recent decades
decades to
to a mutation imposed
imposed by
by their
their emergency departments characterized by chaoticproblem
arrivals of
confronted
services are
providers in
and recent
oftheir
a good decades to a
quality toIt best
consumers. mutation
is imposed
meet patients
essential that the by their
demand.
offered In this work, we consider the scheduling in
providers and their consumers. It is essential that the offered In this
In this work,
patients. work,
Several westudies
we consider
consider have theshown
the scheduling
schedulingthat problem
problem
one of two in
in
providers
Indeed, there
services areandof their
isasomegoodconsumers.
patient
quality It is essential
dissatisfaction
to best meet that the
generally
patients offered emergency departments characterized
due to emergency departments characterized by chaotic arrivals
demand. by chaotic arrivals of
services are ofof emergency departments
services works characterized
in overdrive, by chaotic
which means arrivals
that of
of
all
services
long
Indeed, are
waiting
there aasome
times
is
good
good quality
quality
or patient
the mismatchto best
to bestbetween
dissatisfaction
meet patients
meet patients
their needs
generally
demand.
demand.
due andto patients. Several studies have shown that one of two
Indeed,ofthere
there is some
some patientproviding
dissatisfaction generally due patients.doSeveral
to patients.
patients Several
not studies
havestudies
the haveofshown
have
privilege shown
beingwhich that one
that
supported onein of of two
two
optimal
Indeed,
skills
long human
waiting is
times patient
resources
or the dissatisfaction
mismatch these
between generally
services.
their needsdue
These
andto emergency services works in overdrive, means that all
long waiting times or the mismatch between their needs and emergency services
emergency
conditions services
with works in
works
extended inwaiting
overdrive,
overdrive, times which
which means that
means
(Bertrand, that all
all
2006).
long waiting
institutions
skills of times
have
human or the
therefore
resources mismatch
a real
providing between
need to
these their
develop
services.needs
a and
more
These patients do not have the privilege of being supported in optimal
patients do not have the privilege of being supported in optimal
skills of
skills of and
efficient
institutions
human
human
rigorous
have
resources
resources
therefore
providing
humanaproviding
resources
real need
these services.
these
management
to
services.
develop
These
aa These
system moreto patients
Planningdoand
conditions
conditions with
not
with
with
have the privilege
resources
extended
extendedand
scheduling
waiting
waiting
of being
times
times
supported
have an impact
(Bertrand,
(Bertrand,
in optimal on
2006).
2006).
institutions
institutions
improve and have
the have therefore
therefore
productivity a real
andaresources
real need
efficiency need to develop
ofto their
develop
organization more
a more conditions
performance
Planning and extended
management
resources waiting
system
scheduling times
control,
have (Bertrand,
typically
an impact 2006).
based
on
efficient
efficient rigorous
and rigorous
rigorous human
human resources management
management system
system to Planning
to Planning
on a globalandand resources
resources
evaluation of andscheduling
scheduling
the existing have an
have
system an impact
impact
(Pham, on
on
2002).
efficient
while
improve and
ensuring
the the human
quality
productivity of
and resources
health
efficiency care management
provided
of their to system
patients.
organization to performance management system control, typically based
improve thethe productivity
productivity and and efficiency
efficiency of of their
their organization
organization on performance
performance
Thea objective management
management
is to provide and
and system
system control,
control,
diagnosissystem typically
typically
and anticipation based
based
of
improve
while ensuring the quality of health care provided to patients. global evaluation of the existing (Pham, 2002).
The
whilemain issue the
ensuring related
the qualityto scheduling
of health
health care in health
care providedcare toinstitutions
to patients. on aa global
on
possibleglobal evaluation
evaluation
changes likely of
of the existing
the
to affect existing
its currentsystem
system (Pham, 2002).
(Pham,
functioning 2002).
by the
while ensuring quality of provided patients. The objective is to provide diagnosis and anticipation of
is to main
allocate human resources to health care tasks considering The objective
The objective
adjustment of someis to
is toparameters
provide diagnosis
provide diagnosis
(Canelon and
and
et anticipation
al. anticipation
2009). by the of
of
The
The main
main issue related
issue related
relatedand to scheduling
to scheduling
scheduling in health
in health
health care institutions
care institutions
institutions possible changes likely to affect its current functioning
The
their issue
availabilities to their in
skills. Humancare resources possible changes
possible changes likelylikely to to affect
affect its its current
current functioning
functioning by by the
the
is to allocate human resources to health care tasks considering adjustment
Resources of some parameters (Canelon et al. 2009).
is to
is to allocate
allocate human
dimensioning human resources
is of resources
highest to health
to health care
importance care
for tasks
tasks considering
considering
hospitals. adjustment scheduling
These adjustment of some
of in health (Canelon
some parameters
parameters care fieldet
(Canelon ethas
al. been
al. 2009).treated in
2009).
their
their availabilities
availabilities and
and their
their skills.
skills. Human
Human resources
resources many researches. For instance, Jebali et al. (2003) proposed a
their availabilities
resources, usually
dimensioning is of and
related
highest their
to high
importance skills.
costs should forHuman resources
be able toThese
hospitals. meet Resources scheduling in health care field has been treated in
dimensioning is of highest importance for hospitals. These Resources scheduling
Resources
methodology scheduling
to produce in health
in health
rules care
care
for field has
field
resource has been treated
been
allocation. treated
Thesein
in
dimensioning
the objectives.
resources, is
usually of
A resourcehighest
related importance
undersizing
to high costs for
isshould hospitals.
a handicapbe able These
to achieve
to meet many researches. For instance, Jebali et al. (2003) proposed a
many are researches. For instance, Jebali et et al.
al.of(2003)
(2003) proposed aa
resources,
resources,
these
the
usually
goalsusually
objectives. while
A
related
related to high
to
oversizing
resource
highleads
undersizing
costs to
costs is
should
should
a
be able
be able to
underutilization
handicap to
to meet
meet
achieve of manyrules researches.
methodology
methodology to
For
usedto toproduce
produce
instance,
define rules
rules
Jebali
the beginning
for
for resource
resource allocation.
allocation.
proposed
care operations.These
These
the objectives.
the objectives.
available A resource
A
resources resource
and undersizing
undersizing
therefore to is aa handicap
is
additionalhandicapcosts. toBesides,
to methodology
Guinet et al. to produce
(2003) rules
proposed
achieve rules are used to define the beginning of care operations.
achieve for
a resource
linear programallocation.
with These
integer
these
these goals
goals while
while oversizing
oversizing leads
leads to
to underutilization
underutilization of
of rules are
rules
variablesare for
usedtheto
used totiming
defineofthe
define the beginning
beginning
surgery not of scheduled
of
yet care operations.
care operations.
taking
these goals
additional
available while and
information
resources oversizing
about leads
patients’
therefore to to underutilization
pathologies
additional received
costs. Besides, of Guinet et al. (2003) proposed a linear program with integer
by
available resources and therefore
therefore to additional
additional costs. Besides, Guinet
Guinet
into et al.
et
account al. the
(2003)
(2003) proposed
proposed
availability of aabeds
linear
linear program
program
in the hospital. with
with integer
A integer
review
available
the medical
additional resources
staff
information and
members
about during
patients’ to the health
pathologies costs.
care Besides,
process
received by variables for the timing of surgery not yet scheduled taking
additional information about patients’ pathologies received by variables
variables
of the for
for
literaturethe
the timing
timing
shows of
of
that surgery
surgery
the not
not
resolution yet
yet scheduled
scheduled
of this taking
taking
problem
additional
makes
the it
medical information
difficult
staff toabout
members patients’
determine
during pathologies
the
the necessary
health received
care medical
process by into account the availability of beds in the hospital. A review
the medical
medicalat staff
staff members ofduring
during the health
health process into
care Further, into account
account
traditionally the
the
usesavailability
availability
a management of
ofthebeds
beds in the
inapproachhospital.
the hospital. A review
Aproblem
focused reviewon
the
treatments
makes it members
the beginning
difficult to determine the
the handling
the care
process.
necessary process
medical of the literature shows that resolution of this
makes it difficult to determine the necessary medical of the
of the literature
resources. literature
Kharraja shows
shows et that(2003)
that
al. the resolution
the resolution
proposed ofa this
of this
tool problem
problem
for the
makes it atdifficult to determine the are necessary medical
due to traditionally uses
the duration
treatments
treatments
ofthe
diagnosis
beginning
atcharacteristics
the beginning
beginning of
andoftreatments
the
of each handling
the handling
handling
stochasticFurther,
process.
process. traditionally
Further, traditionally
automatic uses aaa management
uses
construction
management
management
of a(2003)
master proposed
approach
approach
approach
plan
focused
focusedtime
focused
for allocating
on
on
on
treatments
the
the specificat
duration ofthe
diagnosis and of the
treatments patients.
are process. Further,
The immediate
stochastic due to resources. Kharraja et al. a tool for the
the duration
duration of diagnosis
diagnosis andoftreatments
treatments are stochastic
stochastic due resources.
resources.
slots to minimize
to automatic Kharraja
Kharraja et
et
the riskal.
al. (2003)
(2003)
ofmaster proposed
proposed
over-plan a
a tool
tool
or under-utilization for
for the
the
by
the of and are maydue to construction of
need
the for treatment
specific
the specific
specific
in case
characteristics
characteristics of
of each
severepatients.
each
each and
emergencies
patients. The immediate
The immediate
immediate
also automatic aconstruction
automatic
providing construction
linear mathematicalof aaa master
of master model planand
plan
for allocating
fora allocating
for allocating
heuristic. time
time
time
This
the
cause
need characteristics
disturbances
for treatment in
in the
case of
schedule
of severe patients. The
complications
emergencies may which
also slots to minimize the risk of over- or under-utilization by
needoccur
for treatment
treatment in case
case ofof severe emergencies may also slotsslots to
problem to minimize
minimize
was proposed the to
the risk
risk
be ofof
solvedover-
over- or under-utilization
or
in two under-utilization
steps. The first This by
by
step
need
can
cause for in
during a treatment
disturbances in the aresevere
schedule ableand toemergencies
engender long
complications may also
waiting
which providing aa linear mathematical model and aa heuristic.
cause and
disturbances in the
the schedule
schedule and complications which providing
which providing
is the definition linear
a linear mathematical
of mathematical
an operating model
model
room and
and
planning heuristic.
a heuristic.
by assigning This
This
cause
times
can disturbances
occur modifyapathways
during in
treatment for
are other
able and complications
patients.
to engender long waiting problem was proposed to be solved in two steps. The first step
can occur during a treatment are able to engender long waiting problem was
problem was proposed
proposed to to be
be solved
solved in in two
two steps.
steps. TheThe first
first step
step
can
timesoccur
and during
modify a treatment
pathways are
for able
other to engender
patients. long waiting is the definition of an operating room planning by assigning
times and
and modify
modify pathways
pathways for for other
other patients.
patients. is the definition of an operating room
is the definition of an operating room planning by assigning planning by assigning
times
Copyright © 2015 IFAC 737
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Copyright
Peer review©under
2015 responsibility
IFAC 737Control.
of International Federation of Automatic
Copyright
Copyright ©
© 2015
2015 IFAC
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10.1016/j.ifacol.2015.06.165
INCOM 2015
Sarah Ben Othman et al. / IFAC-PapersOnLine 48-3 (2015) 704–709 705
May 11-13, 2015. Ottawa, Canada
patients to operating rooms. The second is to provide each
individual surgical unit responsible for synchronizing the
various human and material resources used.
We are particularly interested in human resources planning in
pediatric emergency organizations which is not yet processed
according to the state of art analysis. This planning aims to
determine the best balance between patient demand and
involved human resources in order to meet needs for treatment
while minimizing waiting times, optimizing the quality of
health care services and reducing costs. This work belongs to
HOST project (Hospital: Optimization, Simulation and
Crowding Avoidance) supported and financed by the French
National Research Agency (ANR). It targets to optimize the
Pediatric Emergency Department (PED) functioning
characterized by stochastic arrivals of patients which can lead
to its overcrowding. It aims to better manage health care
organizations, anticipate the overcrowding feature and
establish avoidance proposals for it. Our concerns focus on
modeling the human resources allocation in the scheduling
process and also searching for the existence of an assignment
allowing the realization of a health care plan.
This paper is organized as follows: an analogy between job-
shop scheduling and multi-skill health care tasks scheduling is
presented in the second section followed by a mathematical
modelling of the studied problem. Then, the proposed method
will be described in the fourth section. A scenario of
simulation is given in the fifth section. Finally, the last section
is for conclusion and prospects.
2. ANALOGY BETWEEN JOB-SHOP SCHEDULING
AND MULTI-SKILL HEALTH CARE TASKS
SCHEDULING
Health care systems are similar to production systems which
always try to meet demands (patients for the hospital and
customers for industry). A health care system can be
considered as a full production system, constrained by limited
material and human capacity in order to deliver the best care
at the lowest cost. Human resources planning is a central
element of health institutions’ management because of the cost
and the constraints related to it (skills and availability). The
numerous hazards such as the stochastic arrivals of patients
and the complications that can occur during treatment process,
the difficulty of standardization and the coordination of
medical acts with the high number of actors make the planning
a complex process. The implementation of generated plans
requires sustained efforts.
The search for industrial excellence in corporate comes near to
the concept of optimization of the quality of health care
facilities. The specific feature of health care systems is that
they cannot speculate on human suffering and for which the
objective of profit must be dismissed.
The most commonly discussed programming policies in
previous works are those included in workshops. A workshop
is characterized by the number of machines it contains, its type
and the order of their use to make a product. We distinguish
three types of workshops: flow-shop, job shop and open-shop.
We compare in this paper, the scheduling problem in the PED
to a job-shop scheduling problem in industry.
738
Job-shop problems called also Multipath workshops are
workshops where operations are carried out in a fixed order,
vary according to the task. The flexible job-shop is an
extension of the classical job-shop model. Its uniqueness lies
in the fact that several machines are potentially capable of
achieving a subset of operations. Basically, it is a problem of
planning and organization of a set of tasks to be performed on
a set of resources with variable performance (Gotha, 1993).
Similarly, multi-skill health care tasks scheduling corresponds
to assign health care tasks to medical staff members who are
characterized by their skills and availabilities in order to satisfy
patients’ needs while respecting their emergency degrees and
taking into account their length of stay in the PED.
Given a set of tasks and a set of resources, resolving a
scheduling problem corresponds to program tasks and allocate
resources to optimize one or more goals (corresponding to
objective performance criteria), respecting a set of constraints.
The problem of job-shop scheduling consists in organizing the
realization of N jobs on M machines and a job j represents a
number of nj non preemptable ordered operations. In multi-
skill health care tasks scheduling, jobs corresponds to
treatment tasks (a treatment task for each patient), machines
are the medical staff members and health care operations being
executed are also non preemptable. In both cases, the
execution of each operation involves one resource selected
from the set of available resources and at a given time, a
resource can only execute one operation: it becomes available
to other operations once the operation currently assigned is
accomplished (resource constraints). The assignment of an
operation to a resource entails the occupancy of this resource
during a processing time. So, for each flexible job-shop
problem, we can associate a processing time to each operation.
However, because the most important target of health
organizations is to ensure a high quality of care, durations are
not given importance while scheduling in health care process.
In fact, durations of health care operations are uncertain and
not known in advance. They depend on care providers’ skills
and patients’ states. On the other hand, health care demands
can occur unexpectedly. We cannot, in any circumstances
know when the request arises. Requests are prioritized and
scheduled according to emergency degrees. Some requests are
less urgent than others; they can be delayed without
endangering patients’ lives. However, most of the requests in
the PED and the emergency departments in general require
immediate intervention. According to the legal structure of the
hospital, this latter has to accept all patients. In such a
situation, it is necessary to insert urgent patients in the
planning already established, which sometimes causes
malfunctions and usually additional operating costs. This
makes the duration of a treatment operation, which is
determinist in job-shop scheduling problems, undergoes
significant variations depending on the type of operation, the
level of expertise of care provider, the patient and his
pathology, etc. The variability of processing times often leads
to changes in the schedule of the PED activity which may
cause a decline in quality concerning services provided to
patients. The consequences include long waiting times and
additional costs due to overtime. Hence, treatment tasks
durations should be disintegrated while resolving human
resources affectation for health care operations execution. In
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fact, durations of treatment tasks in emergency department are
difficult to calculate and cannot be known in advance. So we
chose to define the Demand Load (DL) of healthcare treatment
in the PED to quantify patient treatment load. The more
progression is, the less healthcare treatment demand will be.
This reflects the progression of health care process for each
patient and gives us an idea about health care operations
already executed and the ones which remain to be done.
In job-shop scheduling a resource (machine) becomes
available to other tasks once the task which is currently
assigned to is completed. Task’s completion time can be
calculated in advance. But, in health care treatment process,
the availabilities of medical staff members depend on their
skills and experience, patient’s health state, pathology severity
degree and the evolution of the current medical treatment task.
To set the availability date, it is hard for experts to afford exact
values due to the uncertainty involved. Besides, the evaluation
is not the same in the eyes of the decision-makers (Issai and
Singh, 2000), it depends on human feeling and recognition. So,
health care providers cannot make the single judgment
(Abbod, 2001).
For the objectives to achieve, it is to minimize the overall
completion time (makespan), the total workload of the
machines in job-shop scheduling, etc. However, in our study,
we aim also to minimize patients waiting time in addition to
balancing workload between all medical staff members and
minimizing the response time as well as the workload of all the
medical staff in the PED.
3. MATHEMATICAL MODELING
Notation
M: number of available medical staff members,
k: index of medical staff member Mk,
j: index of treatment task Tj,
nj : number of operations of treatment task Tj,
rj : earliest starting date of task Tj,
i: index of a health care operation,
Oi,j : ith operation of task Tj,
ri,j : the earliest availability date of operation Oi,j,
Nt : total number of operations to execute, Nt n j ,
j two difficulties. The first one is to assign each operation Oi,j
Pt : total number of patients waiting for health care
treatment Pt   Pj ,
j The proposed method consists in two stages of resolution.
𝑑𝑑𝑖𝑖,𝑗𝑗,𝑘𝑘 : execution time of the operation Oi,j,
𝐶𝐶𝑖𝑖,𝑗𝑗,𝑘𝑘 : the skill of the medical staff member 𝑀𝑀k needed for
the execution of the operation 𝑂𝑂𝑖𝑖, 𝑗𝑗 ,
The problem is to organize the execution of N health care
operations by M medical staff members. The set of medical
staff members is U. Each task Tj corresponds to a patient
waiting for treatment in the PED and is a sequence of nj health
care operations. Each operation i of a task Tj (noted Oi,j) may
be performed by a set of medical staff members Ui,j  U.
The affectation of an operation Oi,j to a medical staff member
MSk  Ui,j leads to the occupancy of this medical staff
member for a period di,j,k (we assume that di,j,k  IN*).
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In this issue, we make the following assumptions:
 Each treatment task Tj can be started at the time t = rj;
 Each medical staff member can execute at a time a single
operation (resource constraint);
 The total number of operations to be performed is higher
than that of medical staff members.
Performance Indicators
To evaluate functioning quality of the PED, we define three
performance indicators:
 Minimize the total load of all medical staff members:
The total load is equal to the sum of the lengths of all health
care operations executed according to any assignment.
However, for each operation Oi,j, the length of execution time
is greater than the minimum length  i, j where:
 i , j  min (di , j ,k )
k
With i,j the minimum length of the health care operation
execution for a treatment task Tj and Oi,j is the ith operation.
 
So, this criterion corresponds to minimize Cr1  i, j
j i
 Reduce waiting time of each patient
l
It corresponds to minimize Cr2 = ∑j=1 max(0, cj − dj)
With:
cj = the completion time of the treatment task Tj,
dj = the theoretical treatment time for the task Tj,
l = the total number of treatment tasks.
 Minimize response time to health care tasks
 
It corresponds to minimize Cr3  max  r j    i , j 
j
 i 
The proposed optimization method presented in this work will
focus on balancing the workload of medical staff members (k
€ [1…M]) as well as minimizing the response time for patients’
treatment.
4. METHOD
The studied multi-skill health care tasks scheduling presents
to a medical staff member Mk (selected from the set U). The
second one is the calculation of the starting times ti,j.
4.1 First stage
 Assignment Algorithm
It allows us to assign each health care operation to the suitable
medical staff member taking into account his availability date
and workloads of health care providers to whom operations
have been already assigned. To compute the availability date
of each MSk a simple application of fuzzy logic is proposed.
Calculation is based on analysing the affordable skills, the
evolution of the current treatment task, patient’s health state
and pathology severity degree. These are the inputs. Then, we
define for each input three sub-sets {“Low”, “Medium” and
“High”}. Each subset is characterized by its trapezoidal
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Membership Functions (MF) meanwhile the state varies representation since they act on binary genotypes. In a simple
gradually. After the definition of MF of the variables or genetic algorithm, the search is set by the successive
Inference which is based on decision rules depending on application of the variation operators. The cross is the phase of
experts’ views and historical data. cooperation between individuals while the mutation
corresponds to the individual adaptation phase.
Example of rules:
if (the medical staff is “high qualified”) and (the evolution of We consider the important characteristics of evolutionary
the current act is “high”) and (the pathology is “serious”) and algorithms and their relevance to solve NP-hard problems. We
(patient’s health state is “improves”) then (the medical staff is present some key points for solving approach:
“highly available”).
- A genetic representation (coding) appropriate to the problem
The result which is a fuzzy value undergoes a defuzzification
to determine possible solutions of the optimization problem;
to obtain an exact number as final output using the Center Of
Area method (COA). For the assignment, we choose to assign - Genetic operators that transform the composition of children
the health care operation to the medical staff member who during reproduction. Because a task must be treated by a single
corresponds to the highest fuzzy value which reflects his medical staff member selected from the set of members who
availability rate. If two medical staff members have the same are able to provide the corresponding health care service, we
fuzzy value, we make the choice while balancing the workload choose to correct the solutions generated by another operator
between all health care providers. to meet this requirement;
This assignment procedure allows us to construct a set E of
assignments (E = {Sz / 1≤z≤cardinal(E)}) and balance the - Parents are randomly selected from the current population for
medical staff members workload. Each assignment is the crossover and mutation with a probability of crossover p c
represented in a table Sz, Sz = {Szi,j,k / 1≤j≤N; 1≤i≤nj; 1≤k≤M}. (0 <pc <1) and a mutation probability pm (0 <pm <1);
For each i, j, k, the value of Szi,j,k can take 0 or 1. The value - We take a non-elitist replacement technique to build the new
population;
“Szi,j,k=1” means that Oi,j is assigned to MSk. The value “Szi,j,k=
- Fitness functions evaluate solutions based on two criteria:
0” means that Oi,j isn’t assigned to MSk. medical staff workload and response time.
 Scheduling Algorithm In this stage, we generate from the set E constructed in the first
For each assignment, it calculates starting times ti,j by stage, an assignment scheme to control the genetic algorithm.
considering medical staff availabilities and precedence This scheme is going therefore to represent a constraint that
constraints. Conflicts are resolved by applying conventional must be respected by the new created individuals. This method
priority rules (SPT, LPT, FIFO, LIFO, FIRO (Boucon, 1991), consists in considering the assignments SZ given by the earlier
(Bel and Cavaille, 2001)), so we get a set of plans according to scheduling method and to determine (for each operation) the
the applied priority rules. In emergency department priority is set of possible medical staff members using a genetic
given at first to the most urgent cases, then to the patient who algorithm.
has arrived first. The scheduling procedure is as follows: Table 1. Medical Staff Skills
according to the availability date of a medical staff members
and the availability of the corresponding health care operation, C = {Ci,j,k / 1≤j≤N ; 1≤i≤nj ; 1≤k≤M}
the starting time of the operation is the minimum date among MS1 MS2 MS3 MS4
the two availabilities’ dates. O 1 ,1 0.2 0.6 0.5 0.2
T1 O 2 ,1 0.4 0.9 0.3 0.2
4.2 Second stage O 3 ,1 0.4 0.6 0.5 0.8
O 1 ,2 0.5 0.2 0.2 0.5
T2 O 2 ,2 0.3 0.4 1 0.4
The scheduling approach described in the previous paragraph O 3 ,2 1 0.2 0.3 0.3
can contribute to a multi-objective optimization by combining O 1 ,3 0.9 0.7 0.4 0.6
it with genetic algorithms and make develop an initial set of T3 O 2 ,3 0.5 0.6 0.9 0.2
solutions to a final one while improving the performance of
the whole system according to criteria we have fixed at the A possible scheduling plan related to medical staff skills is
beginning (Michalewicz, 1992), (Ono, 1996). given in Table 1. We consider that the assignment of a
health care operation Oi,j to a medical staff member is
Genetic algorithms are the most popular variant of possible when the competence Ci,j,k >=0.5.
evolutionary algorithms. Many specialists designate and
continue to designate the evolutionary approaches as "genetic Table 2. Assignment Sch
algorithms". As their name suggests, genetic algorithms are Sch = { Sch i,j,k / 1≤j≤N ; 1≤i≤nj ; 1≤k≤M}
based on the genetic inheritance of an individual (genotype)
MS1 MS2 MS3 MS4
represented by its chromosomes. The interaction of the O 1 ,1 0 * * 0
genotype of an individual with its environment determines its T1 O 2 ,1 0 1 0 0
phenotype which can be modified by mutation. Phenotype is O 3 ,1 0 * * *
evaluated by coding the genotype, which is often a binary O 1 ,2 * 0 0 *
symbol in order to provide a usable performance value by the T2 O 2 ,2 0 0 1 0
selection of operators. The variation operators (crossover and O 3 ,2 1 0 0 0
O 1 ,3 * * 0 *
mutation) presented above are related to the binary T3 O 2 ,3 * * * 0

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The value " Schi,j,k = 0" indicates that the medical staff member Operator of mutation reducing the response time for
MSk is not enough qualified for this health care operation so treatment for patient j (RTLj)
we cannot assign it to him. Mutation 1
The value " Schi,j,k = 1" indicates that the assignment of the - Select randomly an individual S ;
operation Oi,j to the medical staff member MSk is obligatory - Choose the treatment task j whose response time the most long :
because he is the only one whose Ci,j,k > =0.5, in this case, all (Max j { RTLj such that RTLj =∑i∑k Si,j,k.d i,j,k }) ;
values of the rest of the line (i, j) are equal to "0". - i=1; r = 0 ;
- WHILE (i≤nj And r = 0)
The symbol: " * " indicates that the assignment is possible i.e.  Find K0 such that Si,j,K0 =1;
(Ci,j,k >=0.5).  FOR (k=1, k≤M)
We cannot have the value "1" and the symbol " * " in the same IF (d i,j,k < d i,j,k0 ) Then {Si,j,K0 =0; Si,j,K =1; r=1 ;}
line. End IF
End FOR
The application of the assignment procedure described in the  i=i+1 ;
first stage may give as result the following scheduling S (Table End WHILE
3). - Call to "Scheduling_Algorithm" to calculate the starting and completion
times;
Table 3. Assignment S
The second mutation is responsible for the workload
S: possible scheduling
balancing:
MS1 MS2 MS3 MS4
O 1 ,1 0 0 1 0 Operator of mutation balancing workloads of medical staff
T1 O 2 ,1 0 1 0 0 members
O 3 ,1 0 1 0 0
O 1 ,2 0 0 0 1 Mutation 2
T2 O 2 ,2 0 0 1 0 - Select randomly an individual S ;
O 3 ,2 1 0 0 0 - Find the medical staff member who has the highest workload Mk1 (Maxk {
O 1 ,3 0 0 0 1 Wk / Wk=∑j∑i Si,j,k.di,j,k }) ;
T3 O 2 ,3 1 0 0 0 - Find the medical staff member who has the lowest workload M k2 (Min k {
Wk }) ;
a. Coding - Choose randomly an operation Oi, j such that S i ,j,k1 =1 ;
- Assign this operation to the medical staff member who has the lowest
workload: S i ,j,k1 =0 ; S i ,j,k2=1 ;
We represent the scheduling in the same assignment table S. - Calculate the starting and completion times according to the algorithm
Each Si,j,k=1 and Si,j,k = * are replaced by the couple ( ti,j, tfi,j ) "Scheduling_Algorithm";
where ti,j is the starting time and tfi,j is the completion time. Si,j,k
= 0 remain the same.
5. SIMULATION AND RESULTS
b. Crossover To better understand the proposed approach we present in this
section a scenario of a clinical case in the PED.
It consists in combining elements from two parent We suppose the arrival of 3 patients at time t = 0 to the health
chromosomes into one or more child chromosomes. care institution with 4 medical staff members mastering 3
(Michalewicz, 1992). It allows to create new combinations and types of skills, the degree is between 0 and 1.
enlarge our chance to find a better solution. Our operator uses
a Crossover Mask. We apply an efficient coding inspired from Table 4: Medical staff members
(Kacem et al., 2001) which respects our problem constraints. Medical Staff Description
MS1 Paediatrician
Cossover Algorithm MS2 Nurse1
1 2
- Select 2 parents S and S randomly; MS3 Nurse 2
- Select randomly 2 integers j and j’ such that j≤j’≤N ; MS4 Care assistant
- Select randomly 2 integers i and i' such that i≤nj and i’≤nj’ (in the case
where j=j', i≤i’) ;
- The assignment in f1 must match the same assignments in S1 for the set of
Patient 1 suffers from a mild concussion without loss of
operations between the line (i,j) and the (i’,j’); consciousness, patient 2 suffers from cardiopulmonary arrest
- The rest of assignments in f1 must match the same assignments in S2; and Patient 3 from an uncomplicated pneumonia.
- The assignment in f2 must match the same assignments in S2 for the set of The assignment table of medical staff members is given in the
operations between the line (i,j) and the (i’,j’);
- The rest of assignments in f2 must match the same assignments in S1;
table below:
- Call to "Scheduling_Algorithm" to calculate the starting and completion Table 5: Assignment table with medical staff skills
times;
MS1 MS2 MS3 MS4
O 1 ,1 0.9 0 0 0.9
c. Mutation T1 O 2 ,1 0 0 0.8 1
O 3 ,1 0.7 0 0.6 0
The genetic operators should be therefore able to ensure this O 1 ,2 0 1 1 0
T2 O 2 ,2 0.7 0.6 0 0
optimization according to the criteria presented in the previous
O 3 ,2 0 1 0.8 0
section. Thus, we propose two artificial mutation operators: O 1 ,3 0 0 0.6 0
the first one is responsible for reducing the response time for T3 O 2 ,3 0 0 0 1
patients’ treatment.

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Table 6: Assignment using only the first step In our future works we will consider the rest of the
MS1 MS2 MS3 MS4
performance indicators and we will integrate our approach in
O 1 ,1 0 0 0 0, 10 an intelligent agent-based system.
T1 O 2 ,1 0 0 30, 50 0
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O 3 ,1 50, 80 0 0 0
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Guinet, A. and Chaabane, A. (2003). Une approche de type
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Figure 1: Comparison between results of the first step for Modelling, Control and Automation (CIMCA'01), the
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Figure 1 shows that the evolutionary approach contributes to Kharraja. S. and Marcon, E. (2003). Vers une Construction
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= Evolution Programs. Springer Verlag.
In this paper, we have presented an efficient approach for
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This method evolves two steps: the first one is to apply the problems using job-based order crossover. In ICEC’96,
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